Maximizing the Impact of Voluntary Medical Male Circumcision for HIV Prevention in Zambia by Targeting High-Risk Men: A Pre/Post Program Evaluation

A well-documented barrier to voluntary medical male circumcision (VMMC) is financial loss due to the missed opportunity to work while undergoing and recovering from VMMC. We implemented a 2-phased outcome evaluation to explore how enhanced demand creation and financial compensation equivalent to 3 days of missed work influence uptake of VMMC among men at high risk of HIV exposure in Zambia. In Phase 1, we implemented human-centered design-informed interpersonal communication. In Phase 2, financial compensation of ZMW 200 (~ US$17) was added. The proportion of men undergoing circumcision was significantly higher in Phase 2 compared to Phase 1 (38% vs 3%). The cost of demand creation and compensation per client circumcised was $151.54 in Phase 1 and $34.93 in Phase 2. Financial compensation is a cost-effective strategy for increasing VMMC uptake among high-risk men in Zambia, and VMMC programs may consider similar interventions suited to their context.

Blood specimen collection methods influence the concentration and the diagnostic validity of matrix metalloproteinase 9 in blood

BACKGROUND

Matrix metalloproteinases (MMP) in blood are promising new diagnostic tools. It was shown that the blood sampling process resulted in different blood concentrations of MMPs. To clarify whether the sampling process also influences the diagnostic validity of MMPs, MMP-9 measurements were performed in plasma and serum samples of patients with prostate carcinoma and renal cell cancer.

METHODS

MMP-9 ELISAs were performed in samples of heparin plasma and serum collected in blood tubes with and without clot accelerator. Measurements were undertaken in 78 healthy persons, 33 patients with prostate carcinoma and 33 patients with renal cell carcinoma.

RESULTS

MMP-9 showed higher concentrations in serum samples than in heparin plasma and was about threefold higher in serum samples collected in tubes with clot activator than in native serum samples. Both patient groups had lower MMP-9 concentrations in serum, whereas in plasma, patients with renal cell carcinoma had higher, but patients with prostate cancer unchanged MMP-9 concentrations. 13 of 33 patients with renal cell carcinoma had increased MMP-9 plasma values but no patient had increased serum concentrations.

CONCLUSIONS

To optimise the diagnostic validity of the MMP-9 in blood, measurements should be performed in heparin plasma but not in serum.

Matrix-metalloproteinases and their inhibitors in plasma and tumor tissue of patients with renal cell carcinoma

Matrix-metalloproteinases (MMPs) are associated with invasive and metastatic behavior of several human malignant tumors. We have determined MMP-2 and MMP-9 and tissue inhibitors of MMPs (TIMP-1 and TIMP-2) in blood plasma and in renal tissue samples of patients with renal cell carcinoma (RCC) from cancerous and non-cancerous parts of the same kidney. In tumor tissue, MMP-9 and TIMP-1 were significantly higher than in normal counterparts. MMP-2 was not different between tumor tissue and normal counterparts. TIMP-2 values could not be measured. In plasma, MMP-9 concentrations were significantly higher in RCC patients than in healthy controls, MMP-2 and TIMP-2 concentrations were higher in healthy controls and TIMP-1 concentrations were not different.